A note on intersex and transgender issues

In my response to John Molyneux, I referred to transgender people (the term “trans” is also often used.) There has also been media coverage recently of intersex people, for example following the recent decision in Germany that gender could be left blank on some birth certificates. I’ve become aware that, while some comrades are aware of these issues, for some people this is all new. That’s not surprising, because these issues have become the subject of political discussions only recently: when I was an LGBT activist at university in the early 1980s, for example, we never discussed them. Laura Miles has written an article which will hopefully appear soon in the ISJ, and which provides a fuller explanation. In the meantime, here is a quick briefing.

Intersex people

Some people’s bodies are difficult to fit into the categories “male” and “female”. This happens because, while biological sex is often thought of as one thing, it operates at different levels:

chromosomes (XX or XY)

hormones

gonads (ovaries or testicles)

external genitalia (clitoris or penis, labia or scrotum)

secondary sexual characteristics (breasts, beard etc.)

For example, some people have androgen insensitivity syndrome. They have XY chromosomes, and have testicles which secrete the male hormone androgen. But their tissues don’t respond to the androgen, so they develop as women. At levels 1, 2 and 3 they are male; at levels 4 and 5 they are female, and they will probably live their lives as women.

The word “hermaphrodite”, by the way, refers to a mythical being, a person with both male and female genitals. Intersex people don’t find the word appropriate to their situation.

Intersex people are often identified as such at birth. The response of doctors has often been that they must fit the baby into one sex or the other. They do this, for example, by genital surgery. Parents have been told never to mention what happened to their child, or may not even be aware that their child was intersex, just that there was a “problem” which doctors have corrected. Intersex people may then grow up denied full information about their bodies. The basis on which doctors perform surgeries on ambiguous genitals can sometimes seem very dubious – if a penis is “too small” it may be removed and a vagina created, but how is “too small” defined? The answer seems to be that it means “too small to penetrate a vagina”, which involves various unwarranted assumptions about what it means to be a man.

Genital surgery will also often leave people with scarring and reduced sensation, and people may later regret having surgery to which they could give no consent, and would have preferred to live with the body they were born with. Or they may identify as the other sex from the one they have been assigned to. A better approach is to delay surgery as much as possible till the person involved is old enough to have views about their gender identity, and can give consent knowing the advantages and disadvantages of the procedure.

It is not clear exactly how many intersex people there are – but the common-sense view, that these conditions are very rare, is certainly wrong. A figure often cited is that 1 in 2,000 babies is identified as having ambiguous genitals at birth, and other intersex conditions exist which may only be detected later in life. So perhaps 1 in 1,000 people is intersex, in which case there are about 60,000 intersex people in the UK – about the same as the number of people with Down’s Syndrome. Other authors argue that the number of intersex people is much higher than this.

Transgender people

Some people don’t accept the gender they were assigned when they were born. Their bodies are not ambiguous, as with intersex people. But they strongly feel that they want to live as a member of the other sex, as a member of a third sex, or without identifying as either a man or a woman.

There have been examples of these behaviours all through history and in many societies. Among some Native American peoples, individuals born as men could live their lives as women, or at least as people who could marry men. Sitting Bull had several male wives. In remoter parts of Albania, it’s possible for a person born a woman to make a solemn commitment to live as a man, after which they wear men’s clothes and are called “he” for the rest of their lives.

Since the 20th century it has become possible to use medical technologies such as hormones and surgery to change people’s bodies as part of them living as another gender. These procedures are sometimes called “sex change” operations, but trans people find the term inappropriate and generally refer to people “transitioning”.

“Trans” includes people who go through such medical procedures, but also people who live as the other sex without changing their bodies. It can also include people who behave in ways which don’t fit into the social categories “male” and “female”, such as drag queens or butch lesbians, people who cross-dress, and “tomboy” girls or “sissy” boys. The word for people who are not trans is “cisgender” (“a cisgender woman”, etc.) Acts which oppress trans people are designated transphobic.

Trans people experience great oppression: while one in twelve LGBT students is estranged from their parents, for example, for trans students the figure is one in six. Trans people experience abuse and violence. But trans people also experience oppression by being made invisible, for example by the idea that “everybody is either male-bodied and therefore a man, or female-bodied and therefore a woman” and forms and bureaucracies based on this.

Trans people were involved from the start of the modern gay liberation movement. The Stonewall Inn, where the Stonewall Riots began that started the movement, was frequented by many trans people, who took part in the riot. In fact, trans people had fought back in riots even before Stonewall, such as the Compton’s Cafeteria Riot in San Francisco in 1966. In the movement of the early 1970s, many people questioned simple divisions between male and female. In the last ten to fifteen years, trans people organised as the “T” in the coalition that is LGBT.

Some trans people accept existing ideas of masculinity and femininity. They believe that they are essentially male or female, and seek to change their bodies, and the way they live their lives, to reflect this. Other trans people think that the existence of trans calls the whole gender system into question. Some trans people prefer to live with bodies which are neither wholly “male” nor “female”.

Trans people may or may not have various medical procedures. These include procedures to modify their upper bodies (“top surgery”), their genitals (“bottom surgery”), and their faces (removing beard and Adam’s apple, for example.) In Britain some of these procedures are available on the NHS, though some – such as facial hair removal for trans women – are not, so that trans people have to pay for them, creating a class divide between those who can afford them and those who can’t. Trans people can only get hormones and surgery on the NHS if they meet various criteria: some people have experienced delays and bureaucracy, and found the criteria restrictive, to the point where they experience severe distress and depression, in many cases involving attempted suicide. The NHS process involves a “real life experience” in which a person must live in their new gender identity for at least a year before genital surgery will be approved.

Finally, a specific issue which came up in the Molyneux article is that of trans men giving birth. My impression is that it’s quite common for trans men to decide against having genital surgery, because the results aren’t as satisfactory as those for genital surgery on trans women. Since this means that these men have female genitals, they are able to give birth. A number of them have done so, and this seems to be a growing trend.